经鼻内镜经翼突入路治疗咽旁间隙上部病变
Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space.
作者信息
Li Lifeng, London Nyall R, Prevedello Daniel M, Carrau Ricardo L
机构信息
Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, USA.
出版信息
Head Neck. 2020 Sep;42(9):2734-2740. doi: 10.1002/hed.26127. Epub 2020 Mar 4.
BACKGROUND
Lesions of the upper parapharyngeal space (UPPS) present a surgical challenge. The objective of this study was to ascertain the feasibility of a novel technique of modified transpterygoid approach to the UPPS.
METHODS
Six fresh cadaveric specimens (12 sides) were dissected, developing a technique that includes en bloc mobilization of the lateral pterygoid plate and muscle to access the UPPS.
RESULTS
Following an endoscopic Denker's approach and the removal of posterolateral wall of the antrum, the lateral pterygoid plate was detached from the pterygoid process. Subsequently, the lateral pterygoid plate and muscle were displaced laterally as a unit, allowing the identification of the posterior trunk of V and the fat in prestyloid compartment. Dissecting off the styloid aponeurosis affords entering the poststyloid UPPS exposing the internal carotid artery, internal jugular vein, and cranial nerves IX to XII.
CONCLUSION
This novel modification of the endonasal transpterygoid approach offers a viable alternative for access to the UPPS.
背景
咽旁间隙上部（UPPS）病变带来了手术挑战。本研究的目的是确定一种改良经翼突入路至UPPS的新技术的可行性。
方法
解剖6个新鲜尸体标本（12侧），开发一种包括整块游离翼突外侧板和肌肉以进入UPPS的技术。
结果
在内镜Denker入路并切除上颌窦后壁后，翼突外侧板从翼突分离。随后，翼突外侧板和肌肉作为一个整体向外侧移位，从而能够识别V神经后干和茎突前间隙内的脂肪。剥离茎突腱膜可进入茎突后UPPS，暴露颈内动脉、颈内静脉以及IX至XII对脑神经。
结论
这种经鼻翼突入路的新改良方法为进入UPPS提供了一种可行的替代方法。
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